Retro-orbital pain as mentioned in books is present in only up to 15% of cases admitted in Delhi. The importance of platelet transfusion has been blown out of proportion. Even in cases of dengue hemorrhagic fever (DHF), there has been no bleeding at platelet count 2000 cell/cumm and up to 1000 cell/cumm in other SEA countries. Prophylactic platelet transfusion is not indicated in children at all. It is blood transfusion.

Bleeding can be observed both in DF and DHF. DHF can be differentiated from dengue fever by evidence of plasma leakage.

Prolonged prothrombin time (PT), INR > 1.3-1.5, which is the result of liver failure: Major contributing factor for massive bleeding.

There is no evidence to support the use of blood components such as platelet concentrates, fresh frozen plasma or cryoprecipitate. Its use could contribute to fluid overload.

Important instructions for treatment of DHF as per guidelines:

If the patient’s condition becomes worse despite giving 20ml/kg/hr crystalloid solution for one hour, replace crystalloid solution with colloid solution such as Dextran or Plasma. As soon as improvement occurs, replace with crystalloid.

In case of severe bleeding; give blood transfusion @ 20ml/kg for two hours. Then give crystalloid IV fluids @ 10 ml/kg/hr for a short time (30 - 60 minutes) and later reduce the speed.

If hematocrit falls, give blood transfusion 10 ml/kg and then give crystalloid IV fluids at the rate of 10 ml/kg/hr. The volume of blood administered should be just enough to raise the red blood cell concentration to normal.

The country’s popular 17th MTNL Perfect Health Mela will be held from 23rd to 31st October, 2010 at NDMC Grounds, Laxmi Bai Nagar, New Delhi. The brainchild of Heart Care Foundation of India, the Mela attracts hundreds of people The event will provide a unique opportunity for the NCR people to have their heart and general health tested and personally be aware about all prevention aspects.

DCI has sent a legal notice to Tribue newspaper for publishing a news against the DCI president Dr Anil Kohli (Tribune News Service, published IN The Tribune (Delhi Edition) at page 4 (Delhi and Neighborhood) captioned under the heading of "DCI Chief quits" on 21.07.2010 v). In the notice by Maj. Gen. (Retd.) Dr. P. N. Awasthi, Secretary, DCI, DCI has said that Dr. Anil Kohli is the President, Dental Council of India. "He is the most decorated dental surgeon in the country, having been conferred with many rare distinctions, including: Padma Shree' and 'Padma Bhushan', by the President of India; Honorary rank of Brigadier in the Army Dental Corps by the Chief of the Army Staff on behalf of the President of India; FDS RCS by the Royal College of Dental Surgeons (UK); Dr. BC Roy National Award and S S Bhatnagar Award for outstanding contribution in Medical Field by KG's Medical College, Lucknow." He has also been awarded the 'Ayurvigyan Shree' by Hon'ble Dr. A.P.J. Abdul Kalam; then President of India; 'Merit Award' for 2006 from Head Office, Pierre Fauchard Academy, USA (India Section). As per DCI that Tribune's unsubstantiated allegation of corruption has maligned the character and fair image of the President as well as the Dental Council of India. The DCI refuted these allegations leveled against the Council and its functionaries.

The DCI wrote" Moreover, he has reason to believe that you have made such allegations deliberately and with intend to tarnish the name and reputation of Dr. Anil Kohli, Dental Council of India and its functionaries. As such, we take serious and strong exception to your personal vilification against the Council and its President which requires immediate withdrawal such defamatory allegations within 24 hours hereof, failing which we would be left with no option but to take such action against you before Court of Law. In these circumstances, you are hereby once again requested to (i) withdraw the allegations leveled against Dr. Anil Kohli, Dental Council of India and its functionaries in aforesaid news as the news reported by TNS is false, baseless and without any ground reality and (ii) apologize to the undersigned for making wild allegations and accusations to defame and malign the Council and its functionaries, failing which this Council would be left with no option but to initiate legal proceedings against you for your attempt to malign and defame us before the court of law".

Astro turf grounds in Delhi: how safe?

Synthetic astro turf is one of the option for top level hockey matches and to improve the consistency of the ball-surface interaction and to increase the speed of the game. STI polyethylene and polypropylene grass are being used as an alternative to nylon which require extensive watering at significant economic and environmental costs. More and more clubs are considering polyethylene s for hockey fields because of the "player friendly" feel to the surface, the durability and the cost effectiveness of the pitch compared to nylon. Whether the surface is sand filled or sand dressed, the non-directional qualities of STI knit-de-knit s ensure that the ball roll is fast and the game itself is played at a skilful pace.

Astro turf is now also considered as an alternative to grass at other places also incluind some homes. The reason why some oppose the laying of the astroturf is because this becomes extremely hot and is not environment-friendly as it cannot produce oxygen. Also people who get injured over the turf grass are more proe to get MRSA infections. With pesticides and fertilizers in grass and chemicals in artificial turf, the public is confused which to choose.

International

Perimenopause describes the time just before onset of menopause

Menopause means absence of a menstrual period for 12 consecutive months. Perimenopause is the time around menopause. During this period, production of hormones by the ovaries decreases and a woman is unable to conceive. Peri-menopause usually occurs between ages 45 and 55, thought it may occur as early as the 30s. Symptoms of peri-menopause include changes in menstruation, hot flashes and night sweats, changes in mood, irritability, insomnia, insomnia, and changes in hair growth.

No Heart Benefit from Omega-3 in Women with Type 1 Diabetes

A University of Pittsburgh Graduate School of Public Health study reports that consuming higher amounts of omega–3 fatty acids does not appear to lower heart disease risk for women with type 1 diabetes. The study results were presented at the 70th Scientific Sessions of the American Diabetes Association (ADA).

A High–Fat Diet Alters Crucial Aspects of Brain Dopamine Signaling

Prolonged exposure to a high fat diet is correlated with alterations in the brain chemical dopamine within the striatum. Dopamine is a crucial component of the brain's reward system. The study findings will be presented at the Annual Meeting of the Society for the Study of Ingestive Behavior (SSIB), the leading society for research into all aspects of eating and drinking behavior.

More Than Half the World’s Population Gets Insufficient Vitamin D, Says Biochemist

Vitamin D surfaces as a news topic every few months. What should be the ideal daily intake of vitamin D? Can we end up taking too much of vitamin D? Is exposure to sun, which is the body’s natural way of producing vitamin D, the best option? Or instead are supplements adequate?Anthony Norman is a distinguished professor emeritus of biochemistry and biomedical sciences and an international expert on vitamin D. In an article in the 2010 issue of Endocrine Today, a monthly newspaper published by SLACK, Inc., he has observed that half the people in North America and Western Europe get insufficient amounts of vitamin D.

A doctor should not be dogmatic about his opinion, and lawyers also should not expect him to be so. He should be reasonable in his opinions and should not overstate the likelihood of a relationship between cause and effect. The doctor should be ready to defend every finding and conclusion on the report on clinical and scientific grounds in the court of law. He should be aware of professional and scientific viewpoints which might differ from his, and should be familiar with the latest scientific literature in relation to the subject involved. For the purpose of illustrating and clarifying his testimony in the court of law, the medical expert may employ photographs, maps, diagrams, charts, X–rays, skeletons, models, slides, films, tapes, etc., when they are properly verified.The doctor should avoid talking too much, talking too soon, and talking to the wrong persons. Prejudicial and sensational statements should not be made prior to trial. Courts of law are open to the public and the junior doctors should attend the Courts, where they can follow the proceedings, hear the evidence given by thier senior medical colleague as a witness, to familiarize themselves with the procedures of the court of law.

The common symptoms of GERD include those related to the esophagus and the extra esophageal symptoms.

Symptoms related to reflux esophagitis

Epigastric pain

Heartburn

Non–cardiac chest pain

Dysphagia

Hematemesis /melena/ anemia

Excessive crying/ irritability

Extra–esophageal symptoms

Otorhinolaryngeal

Pulmonary

Others

Chronic otitis media

Chronic rhinosinusitis

Hoarseness pain

Globus sensation

Persistent cough

Asthma

Recurrent pneumonias

Persistent respiratory symptoms

Acute life threatening events

Bradycardia

Abnormal posturing/ Sandifier’s syndrome

Dental erosions/ waterbrash

Question of the Day

What is the optimal timing of surgery for the following conditions?
(Dr Jyotsna M Kirtane)

Congenital inguinal hernia: Needs an early operation as the hernia can get obstructed and strangulated, especially in a small infant.

Congenital hydrocele: One can wait till the child is one year of age as there is no risk involved. Small hydroceles may disappear by the age of one year. The operation is same as in case of inguinal hernia, viz. herniotomy.

Umbilical hernia: Does not generally get obstructed. It can reduce in size and disappear once the child starts to walk and the rectus abdominis muscle gets stronger. If it does not disappear by about 18 months, it can be operated. In case there is history of irreducibility of the hernia, it should be operated upon earlier.

Undescended testes: These should be brought down by the age of one year as they undergo degenerative changes thereafter. If there is an obvious inguinal hernia associated with the undescended testis, orchiopexy should be done earlier.

Hypospadias: Ideally, a boy with hypospadias should undergo urethroplasty between 6 to 18 months.

Public Forum (Press Release for use by the newspapers)

Nicotine and ulcerative colitis

Nicotine therapy may be of benefit to a limited number of patients with refractory ulcerative colitis said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India & MTNL Perfect Health Mela.

Several epidemiologic studies have suggested a protective effect of nicotine on ulcerative colitis disease activity.

Two placebo controlled trials, published in the New England Journal of Medicine and Annals of Internal Medicine, of transdermal nicotine in active mild ulcerative colitis showed a beneficial effect of nicotine therapy. The first study, evaluated 72 patients, all of whom were treated with mesalamine and 12 of whom received corticosteroids. Treatment with a nicotine patch (15 to 25 mg per 24 hours) led to complete remission in 17 of 35 patients versus only 9 of 37 given placebo. Side effects were considerable in those patients who were nonsmokers.

Transdermal nicotine is not effective for maintaining remission in ulcerative colitis. Thus, it may be used to bring patients into remission who will then require additional forms of maintenance therapy.

Ulcerative colitis is an inflammatory bowel disease of uncertain etiology that is characterized by recurring episodes of inflammation primarily involving the mucosal layer and occasionally the submucosa of the colon.

An Inspirational Story

Sand and Stone

A story tells that two friends were walking through the desert. During some point of the journey they had an argument, and one friend slapped the other one in the face. The one who got slapped was hurt, but without saying anything, wrote in the sand: "TODAY MY BEST FRIEND SLAPPED ME IN THE FACE."

They kept on walking until they found an oasis, where they decided to take a bath. The one, who had been slapped, got stuck in the mire and started drowning, but the friend saved him. After the friend recovered from the near drowning, he wrote on a stone: "TODAY MY BEST FRIEND SAVED MY LIFE."

The friend who had slapped and saved his best friend asked him, "After I hurt you, you wrote in the sand and now, you write on a stone, why?"

The other friend replied: "When someone hurts us, we should write it down in sand where winds of forgiveness can erase it away. But, when someone does something good for us, we must engrave it in stone where no wind can ever erase it."

Learn to write your hurts in the sand, and to carve your benefits in stone.

IJCP Special

Dr Good Dr Bad

Situation: A patient with fever and low TSH had ESR > 100.Dr Bad: It’s TB. Dr Good: Its thyroiditis.Lesson: Typically thyroiditis has very high ESR and low TSH.

Make Sure

Situation: A patient was brought to the ICU in cardiogenic shock. Reaction: Oh my God! Why didn’t you take him for emergency angiography and subsequent PTCA.Lasson: Make Sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of NRMI–2, an ongoing trial suggest that this intervention is much better than thrombolytic therapy in such patients.

Quote of the Day

"Words are, of course, the most powerful drug used by mankind." Rudyard Kipling

Are you fit to fly?

Mental illness

Patients with psychiatric disorders that predispose to violent, disruptive, unsafe, or unpredictable behavior should not travel by air, nor should patients at risk for alcohol or drug withdrawal.

Milestones in Orthopedics

William Hey (1736- 1819) was an English surgeon. He gave his name to Hey's amputation (a tarso-metatarsal amputation), Hey's internal derangement (dislocation of the semilunar cartilages of the knee joint), Hey's ligament (the semilunar lateral margin (falciform margin) of the fossa ovalis), and Hey's saw, used in skull surgery.

International Medical Science Academy Update (IMSA)

Dyslipidemia

Based upon an analysis of the National Health and Nutrition Examination Survey (NHANES) from 1996 to 2006, the prevalence of dyslipidemia in adolescents (age range 12 to 19 years) was 20.3 percent.

Q: Are there any deductions if contributions are made to state government fund set up for providing medical relief to the poor?

Ans. A doctor gets deduction if he contributes to any fund set up by a state government to provide medical relief to the poor. For that, proof of payment should be attached with the return.

Lab Medicine (Dr Arpan Gandhi and Dr Navin Dang)

Creatinine Clearance Test

Evaluates the rate and efficiency of kidney filtration. It is used to help detect and diagnose kidney dysfunction and/or the presence of decreased blood flow to the kidneys.

In patients with known chronic kidney disease or congestive heart failure (which decreases the rate of blood flow), the creatinine clearance test may be ordered to help monitor the progress of the disease and evaluate its severity.

Humor Section

Jokes

Circumcision

One day in the hospital, two little boys were lying on stretchers next to each other outside of the operating room. The first boy leans over and asks, "What are you in for?"

"I’m here to get my tonsils out and I'm nervous," the second boy says.

The first kid says, "You’ve got nothing to worry about! I had that done when I was four. They put you to sleep and when you wake up they give you lots of ice cream and Jell"O. It’s a breeze!"

"Well what are you here for?" the second kid asks.

"A circumcision." The first kid replys woefully.

The second kid says "Wow! I had that done when I was born and I couldn’t walk for a year!"

Medical bloopers on medical charts!

Rectum…………………………Damn near killed him

Readers Responses : the rupee fond

Dear All, Now get the new ` symbol on your computer. Save the attached font in your font’s folder (Fonts folder is in control panel). Open word document. Select "Rupee Foradian" from fonts list ( control D) and press the key (~) just above "tab" button in your keyboard. You will get new Indian Rupees symbol. Regards: Sumit Chugh, Marketing Manager, Win-Medicare Pvt. Ltd., New Delhi, email: sumit.chugh@winmedicare.com

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, Cultural Hungama and Live Webcast. Suggestions are invited.

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